title: Japanese multicenter experience of endoscopic necrosectomy for infected walled-off pancreatic necrosis: The JENIPaN study.
abstract: OBJECTIVE
  Only a few large cohort studies have evaluated the efficacy and safety of endoscopic necrosectomy for infected walled-off pancreatic necrosis (WOPN). Therefore, a multicenter, large cohort study was conducted to evaluate the efficacy and safety of endoscopic necrosectomy and to examine the procedural details and follow-up after successful endoscopic necrosectomy.
  
  
  METHODS
  A retrospective review was conducted in 16 leading Japanese institutions for patients who underwent endoscopic necrosectomy for infected WOPN between August 2005 and July 2011. The follow-up data were also reviewed to determine the long-term outcomes of the procedures.
  
  
  RESULTS
  Of 57 patients, 43 (75 %) experienced successful resolution after a median of 5 sessions of endoscopic necrosectomy and 21 days of treatment. Complications occurred in 19 patients (33 %) during the treatment period. Six patients died (11 %): two due to multiple organ failure and one patient each from air embolism, splenic aneurysm, hemorrhage from a Mallory - Weiss tear, and an unknown cause. Of 43 patients with successful endoscopic necrosectomy, recurrent cavity formation was observed in three patients during a median follow-up period of 27 months.
  
  
  CONCLUSIONS
  Endoscopic necrosectomy can be an effective technique for infected WOPN and requires a relatively short treatment period. However, serious complications can arise, including death. Therefore, patients should be carefully selected, and knowledgeable, skilled, and experienced operators should perform the procedure. Further research into safer technologies is required in order to reduce the associated morbidity and mortality.
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, Gifu 501-1194, Japan. YASUDAIC@aol.com
authors.forename: I
authors.initials: I
authors.lastname: Yasuda
authors.forename: M
authors.initials: M
authors.lastname: Nakashima
authors.forename: T
authors.initials: T
authors.lastname: Iwai
authors.forename: H
authors.initials: H
authors.lastname: Isayama
authors.forename: T
authors.initials: T
authors.lastname: Itoi
authors.forename: H
authors.initials: H
authors.lastname: Hisai
authors.forename: H
authors.initials: H
authors.lastname: Inoue
authors.forename: H
authors.initials: H
authors.lastname: Kato
authors.forename: A
authors.initials: A
authors.lastname: Kanno
authors.forename: K
authors.initials: K
authors.lastname: Kubota
authors.forename: A
authors.initials: A
authors.lastname: Irisawa
authors.forename: H
authors.initials: H
authors.lastname: Igarashi
authors.forename: Y
authors.initials: Y
authors.lastname: Okabe
authors.forename: M
authors.initials: M
authors.lastname: Kitano
authors.forename: H
authors.initials: H
authors.lastname: Kawakami
authors.forename: T
authors.initials: T
authors.lastname: Hayashi
authors.forename: T
authors.initials: T
authors.lastname: Mukai
authors.forename: N
authors.initials: N
authors.lastname: Sata
authors.forename: M
authors.initials: M
authors.lastname: Kida
authors.forename: T
authors.initials: T
authors.lastname: Shimosegawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage; D016145:Endoscopy, Digestive System / Q000009:adverse effects; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000382:microbiology / Q000601:surgery; D010179:Pancreas / Q000473:pathology* / Q000601:surgery*; D010182:Pancreatic Diseases / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D007507:Therapeutic Irrigation; D055815:Young Adult